The CareFirst Plan: What It Can Do for You

>> List of Out-of-Pocket Costs

All full-time students, with the exception of evening law students, must either carry the CareFirst health insurance plan offered by the University or demonstrate that they are covered by an equivalent plan. If you purchased the University CareFirst plan, you have enrolled in a Preferred Provider Organization. Under such a plan, your out-of-pocket costs will be lower if you select a preferred provider (providers who have agreed to provide their services to plan members at reasonable group prices), although some of your costs may be covered regardless of the provider you select. A PPO differs from a Health Maintenance Organization in that it allows you direct access to the services of a provider--even a specialist--without first seeking permission from a primary care physician (or Student Health).

Your CareFirst PPO is honored nationwide under the "Blue Card PPO Program." To find the nearest provider, from anywhere in the country, call the Blue Card PPO Access Line at 800-810-BLUE (2583). For services requiring pre certification or prior authorization you must also call CareFirst in order to ensure that you receive the maximum allowed benefits.

The following services are available at the indicated costs to the covered individual:

  • Annual physical exam: no charge
  • Annual GYN exam: no charge
  • Sick visits: $20 co pay
  • Allergy shots: $20 per injection.
  • Outpatient care for accidental injury, if obtained within 72 hours of the injury: $50 co payment.
  • Emergency room visits, if you have a medical emergency as defined by CareFirst: no cost.
  • Testing for disabilities: Contact Educational Support and Disability Services at 410-706-5889 for information on the procedures you must follow to access this benefit.

This policy also covers outpatient surgery, maternity care, diagnostic testing, hospitalization, and numerous other services. For a more complete description of coverage, see the plan booklet. You may use any CareFirst preferred provider as a source of these services, including Family Medicine practitioners based in Student Health, or you may select an out-of-network provider.

Identification 

CareFirst plan enrollees will receive a plan ID card. In some instances, a student covered by the CareFirst plan has more than one option as to how to access a particular service. For example, the student may arrange a sick visit through Student Health, with a CareFirst preferred provider, or with an out-of-network provider. Similarly, birth control pills can be obtained from Student Health (but only if gynecological examinations and Pap smears are obtained there as well) or are included in the prescription coverage of the CareFirst plan. Out-of-pocket costs to the student will depend on the option selected. It is the student's responsibility to understand, before treatment begins, any costs that may be incurred.

CareFirst Prescription Drug Coverage

The campus CareFirst health insurance policy includes prescription coverage. You should note when you fill a prescription that your co pay will depend on whether or not the drug is on the CareFirst formulary. A formulary is a collection of drugs for which CareFirst has negotiated particularly favorable prices with the manufacturer. It will generally include at least one drug for the treatment of any particular ailment.

Your co pay will be $15 if a generic drug is prescribed, $35 for a non generic drug on the formulary, and $60 for a brand-name drug that is not on the formulary. Self injectable medications will cost 50% to a maximum of $100. The maximum annual amount the insurance will pay for your drug benefit is $5,000. You will need to pay the full price for any prescriptions filled after you have used up the annual maximum. Be sure to present your benefit card when filling prescriptions even after you have used your annual maximum benefit since you may be eligible to receive a price discount as a member of the group.  Be certain to discuss with your physician the possibility that a generic or formulary drug will be suitable to treat your ailment. Choosing this option will save you money. You can read more information on the CareFirst formulary on their website.

The CareFirst Plan: Administrative Details and Definition of Terms

The CareFirst student health insurance plan is administered by Student Accounting. You can call them at 410-706-2930 or visit their office in the Health Sciences/Health Services Library (HS/HSL), second floor. Copies of the benefit summary and comprehensive documents describing the CareFirst plan are also available online at http://www.fincsvc.umaryland.edu/sa/ 

Enrolling or Renewing Coverage 

Students are required to enroll in the health care plan online. Students must enroll here. If you wish to receive your insurance card at the beginning of August, you must complete your enrollment before July 22. Your insurance cards will be mailed 2-3 weeks after you complete your enrollment. If you have neither enrolled nor filed a waiver by September 15 (February 15 for new full-time spring students), you will be automatically enrolled for individual coverage as required by University policy. If you have questions, please call Student Accounting at 410-706-2930.

Adding New Dependents

If you get married, have a baby, or adopt a child and want to cover your new dependent under this plan, you need to add him or her to the plan within 30 days. You can enroll them here.

Terminology

  • Allowed Costs These are the fees set by CareFirst and its network of preferred providers for particular services. Allowed costs differ for preferred providers and out-of-network providers. See full list of costs here.
  • Deductible The dollar amount for which you are responsible before CareFirst pays its portion of the cost of covered services.
  • Duration of coverage Coverage initially begins on August 1 and ends on January 31 with the second coverage period beginning on February 1 and ending on July 31, until you are no longer eligible or until you waive coverage. Students who arrive on campus at a time other than the beginning of a semester can sign up for the CareFirst plan as soon as they arrive by contacting Student Accounting (410) 706-2930. Coverage remains in effect for any semester in which you registered and paid the premium. Eligibility ends when you fail to register for a semester. Coverage ends for your dependents, if you have enrolled them (see above right), when your coverage ends or their eligibility ends.
  • Emergencies CareFirst coverage will apply only to emergency room visits that meet their definition of an "emergency." Specifically, a medical emergency, according to the CareFirst plan, is "the sudden onset of a medical condition resulting in: placing your health in danger, causing other serious medical problems, causing serious impairment to bodily function, or causing serious and permanent damage to any body part." Arriving at the hospital unconscious or in acute pain is also considered a medical emergency. Note that the University of Maryland Medical Center's ER is a CareFirst preferred provider.
  • Extension of coverage Students who leave the University, either as a result of graduation or due to termination of enrollment for other reasons, are eligible for CareFirst major medical conversion coverage. Information on this option is mailed to all graduates and can be obtained from CareFirst (Individual Marketing Division: 800-458-1981).
  • Family members Students may enroll eligible dependents (spouses and unmarried children between birth and the end of the calendar year in which they turn 25) in the CareFirst plan. A Social Security number is required for each family member. Eligible dependents may select Family Medicine physicians based at Student Health or other physicians as their preferred providers. Note that they are not entitled to other Student Health services.
  • International students The University's CareFirst student health insurance meets Immigration and Naturalization Service requirements for international students, including coverage for the repatriation of remains and for medical evacuation.
  • Out-of-pocket maximum Once the covered student (or family) has expended this amount out-of-pocket in a given calendar year, CareFirst is responsible for all additional covered costs.
  • Pre certification Pre certification is the process by which approval for a service is obtained before provision of that service. Services requiring pre certification include, but are not limited to, surgery, hospitalization, in-patient mental health care, and therapy. Failure to pre certify any hospital or inpatient mental health or substance abuse admission will result in a maximum penalty of $500. Failure to pre certify physical, speech, or occupational therapy will result in termination of benefits after the tenth visit.
  • Preferred providers A network of physicians and hospitals, called preferred providers, has agreed to provide services to those covered by the CareFirst student health plan at reasonable group prices. Many physicians nationwide and all of those associated with the University of Maryland Medical System are preferred providers. To determine the status of a particular provider, call 800-235-5160 or visit the CareFirst website. Should you decide not to use a preferred provider, the provider's services will still be covered, but the cost to you will probably be greater.
  • Repatriation and foreign travel benefits International students enrolled in the CareFirst student health plan receive repatriation and evacuation benefits. They meet INS requirements for repatriation and emergency evacuation of international students.

Phone

  • 800-537-5964 Customer service.
  • 800-235-5160 Preferred providers.
  • 800-241-3371 Prescription card information.
  • 800-294-3446 To pre certify. (Or visit CareFirst online.)